Autistic adults may have distinct relationship preferences and perceptions compared to non-autistic individuals. The Double Empathy Problem suggests that autistic people often experience greater mutual understanding and connection when interacting with other autistic individuals. While some research has examined these relationships, few studies have focused on a range of relationship types. This study aimed to address this gap by qualitatively exploring how autistic adults prefer and perceive their relationships with other autistic people across friendships, romantic relationships, mentoring/support, employment, and volunteering relationships. We surveyed autistic adults living in Australia and New Zealand to better understand their preferences and perceptions regarding these relationships. Written responses from 142 participants were analysed using a reflexive thematic analysis framework. Many autistic adults valued intersubjectivity, mutual understanding, and acceptance in their relationships with other autistic individuals. Within these relationships, they could be authentic and unmask; however, they also had to consider and balance their relational capacity. In addition, some participants experienced conflict in their relationships due to differences in compatibility. While within-neurotype relationships are beneficial for many autistic individuals, they are not always seamless, and challenges and conflicts can still arise. Like all relationships, autistic-autistic relationships are complex and nuanced.Lay AbstractMany autistic people enjoy spending time with other autistic individuals because they feel more comfortable and better understood in these relationships. While some research has explored autistic adults' relationships with other autistic people, less is known about their preferences and perceptions within these relationships. To learn more, we surveyed autistic adults in Australia and New Zealand about a range of relationship types they may have with other autistic people (i.e. friendships, romantic relationships, mentoring/support, employment, and volunteering relationships). We then analysed written responses from 142 participants using a reflexive thematic analysis to identify themes within the data set. Participants valued intersubjectivity, mutual understanding, acceptance, and a sense of belonging and described being able to unmask and be authentic in these relationships. However, they also had to consider and balance their relational capacity. While shared neurotype was important, other factors like shared interests, values, and emotional compatibility also influenced relationship satisfaction. Some participants also described challenges or conflicts due to differences in compatibility. These findings highlight that many autistic adults have meaningful relationships with other autistic people, challenging a deficit-based perspective. At the same time, they show that shared neurotype alone does not guarantee compatibility. Instead, the Double Empathy Problem should be understood as a spectrum influenced by factors such as shared life experience and social understanding, reminding us that, like all relationships, those between autistic people are complex and nuanced.
Do children's perception of their parents' math attitudes contribute to their own math anxiety? From 2023 to 2024, one hundred and six parent (53.8% White, 76.4% Mothers) child (Mage = 8.75, 49.1% White, 54.7% Female) dyads in Canada reported their own math anxiety and children additionally reported their perception of parents' math enjoyment. Higher parental math anxiety predicted lower perceived parent math enjoyment, especially for girls. Children's perception of their parents' math enjoyment also moderated the relation between parents' and children's math anxiety. These findings reveal children's perception of parental math attitude as a novel social mechanism in the intergenerational transmission of math anxiety and identify a link between gender differences in math anxiety and the development of children's emotional awareness. This study examined whether children's perceptions of their parents’ attitudes toward math influence their own math anxiety. Over one hundred parents and their children in Canada reported their math anxiety levels, and children also shared how much they thought their parents enjoyed math. Results showed that when parents had higher math anxiety, children perceived them as enjoying math less, particularly among girls. Additionally, how children viewed their parents’ enjoyment of math influenced the relation between parent and children's math anxiety. These findings suggest that children's perceptions of parents’ math attitudes play an important role in the intergenerational transmission of math anxiety and suggest connections between gender differences in math anxiety and how children develop emotional awareness.
Cognitive motivation reflects, among other aspects, the dispositional tendency to seek, engage in, and enjoy cognitively stimulating activities as well as intellectual novelty. Individuals with high cognitive motivation should show higher state motivation and a more positive affect in cognitive challenges but its conceptualization might also suggest lower stress in such activities. Since the interplay of these variables has to our knowledge not yet been examined using a purely cognitive stressor, participants in the present laboratory study (N = 201) were exposed for 20 minutes to a series of highly demanding reasoning tasks. Subjective stress during the experiment was measured five times using the Negative Affect subscale of the PANAS and a single visual analogue scale (VAS) item. Salivary alpha-amylase (sAA) and cortisol were assessed as physiological stress indicators. Structural equation modelling was used to test whether cognitive motivation is directly associated with stress, and whether there exists an indirect effect via motivation to work on the tasks and the enjoyment of the tasks. Subjective stress was positively associated with motivation and negatively with task enjoyment, the indirect effect being significant only in case of the latter. No significant indirect effects were found with sAA or cortisol as outcomes, although the pattern of effects for sAA closely resembled the one observed for subjective stress. Interestingly, our findings suggest a bifurcated effect of cognitive motivation on stress during cognitive challenges: while positive affect might work as a protection, the motivation to face the challenge in fact rather seems to enhance it.
Beach water leisure activities can increase the risk of acquiring infections from recreational water, and children are particularly at risk. However, gaps exist in public awareness of accessing and understanding beach water quality information and the risk of acquiring illnesses. There is no such available research in Canada, and this study was conducted to explore risk perceptions and behaviours of parent beachgoers. We conducted two focus groups in each of three Canadian provinces: Ontario, Manitoba, and British Columbia in July 2023. Participants were parents or guardians of children 15 years or younger, who had taken their children to the beach in the past year. Participants were asked about their family's beach activities, their habits with beach warnings, and any illness experiences related to beach visits. The discussions were recorded, transcribed, and de-identified. Two team members created a coding scheme, analyzed all transcripts independently, and compiled the coded text for thematic analysis. We refined, organized, and interpreted the results in the context of the Health Belief Model (HBM). Four overarching themes were identified: (i) parents and kids participate in and enjoy beach activities, even when water quality advisories are present; (ii) parents acknowledge significant health risks associated with water exposure, though their risk perception often did not recognize risks from ingestion; (iii) parents' and kids' health behaviours at the beach are influenced by preconceived notions and attitudes concerning germs, both before arrival and during their visit; and (iv) parents require accessible and timely beach advisories to help them decide how to enjoy beach activities safely. This study highlights limited awareness among parents and a tendency to downplay the health risks of contaminated beach environments. It emphasizes the need for effective communication about water quality advisories to ensure safer beach experiences, particularly for children, and thereby minimizing impacts on public health.
Among men who have sex with men (MSM), stimulant use (e.g., cocaine, crystal methamphetamine) is both more frequent than in the general population, occurs within sexual settings, and is associated with elevated risk of HIV acquisition and with suboptimal adherence to pre-exposure prophylaxis (PrEP). Understanding stimulant use motives and their relations to patterns and consequences of use among MSM may be important to developing effective interventions unique to this population. In the present study, we sought to validate the Stimulant Use Motives Scale (SUMS), an adaptation of the DMQ-R, among a U.S. sample of 237 HIV negative, adult MSM with past month stimulant use. Using Structural Equation Modeling, a four-factor model was estimated. The four factors were: 1) social motives (enjoying social events more), 2) enhancement motives (liking the feeling/being high), 3) coping motives (with emotions, problems, mood), and 4) sexual motives (enjoyment, less inhibited or nervous). The 12-item four factor model demonstrated acceptable fit. Social motives were negatively associated with stimulant use consequences (p < 0.05). Enhancement motives were positively associated with frequency of stimulant use in the context of sex (p < 0.001) and general stimulant use frequency (p < 0.05). Coping motives were positively associated with consequences (p < 0.05). Sexual motives were negatively associated with poly-stimulant use (p < 0.05). Depressive symptoms were also associated with stimulant use frequency and consequences (p < 0.05). The present study highlights the importance of addressing specific motives in targeted interventions, providing an understanding of stimulant use patterns and associated sexual risk for HIV among MSM.
Joy is an underexplored dimension in autism research, particularly within family life. This qualitative study examined how autistic adolescents and young adults (AYAs) and their families experience and co-create joy. Using a phenomenological design and reflexive thematic analysis, we analyzed 2-week family joy journals from six families (17 participants: six AYAs, two siblings, and nine caregivers). Journal entries revealed joy as a relational process embedded in everyday routines, creative engagement, and shared experiences. Three overarching themes emerged: Experiences of Everyday Joy (sensory pleasures, creativity, and togetherness), the Relational Nature of Joy (co-experienced joy and creativity), and the Layered Nature of Joy (complex intersections of sensory, emotional, and social dimensions). Families described joy as spontaneous yet deeply meaningful, often heightened by the journaling process. Findings challenge deficit-based narratives by highlighting emotional richness and enjoyment experienced within autistic AYAs and their families. Journaling may hold promise as a supportive routine by drawing attention to protective relational processes such as empathy, reciprocity, and connection. This study highlights the significance of acknowledging joy as a potential catalyst for well-being and flourishing in autism research and practice.Lay AbstractJoy is an essential part of life, yet it is rarely studied in autism research. This study explored how autistic adolescents and young adults (AYAs) and their families experience joy in everyday life. We invited six families to keep a "joy journal" for 2 weeks, asking them to write down what brought them joy each day. Seventeen people participated, including six autistic AYAs, two siblings, and nine caregivers. The family joy journals revealed that joy often stemmed from simple, familiar activities, such as reading, listening to music, sharing meals, or spending time with pets. Creative activities, such as drawing, dancing, and playing games, were also familiar sources of joy. Families described joy as something that happens together, not just alone. Many caregivers wrote about feeling joy when they saw their child happy or proud, and AYAs often mentioned enjoying time with family and friends. Three main themes emerged: Experiences of Everyday Joy, the Relational Nature of Joy, and Layered Experiences of Joy, in which sensory pleasure, emotional connection, and shared routines combine. Families reported that the journaling process helped them notice and appreciate joyful moments more frequently. These findings challenge stereotypes that autistic people lack positive emotions. Instead, they show that joy is abundant and deeply relational in autistic AYAs and their families. Recognizing and nurturing joy can strengthen family bonds and support well-being. Simple practices like joy journaling may help families focus on their strengths and create more supportive environments.
This study evaluated the implementation of a social media-integrated learning activity by examining student perceptions, engagement, and EO-aligned performance to determine whether this approach is a feasible, enjoyable, and effective strategy for supporting informatics skill development in pharmacy students. This descriptive observational study assessed a TikTok® informatics activity implemented in an integrated laboratory skills course for 55 third-year student pharmacists in Spring 2025. Students worked in 14 small groups to create informatics-themed TikTok® commercials. After the activity, students completed a brief demographic and perceptions survey. Faculty evaluated videos using a 36-point analytic rubric aligned with AACP educational outcomes: Scientific Thinking (EO 1.1), Problem-solving (EO 2.1), Communication (EO 2.2), and Population Health Impact (EO 2.8). Descriptive statistics summarized performance, and Kruskal-Wallis H and chi-square tests examined grade differences. All students participated in and completed the survey. The cohort was 73% female (n = 40) and 27% male (n = 15), with most identifying as white (84%) or Black (11%). Students reported the activity encouraged an innovative mindset (76%), and 96% enjoyed watching their peers' commercials. Student performance was strong at 32.1/36 (89%), with scores ranging from 26 to 35. Compared to Communication and Population Health domains, Problem Solving (EO 2.1) and Scientific Thinking (EO 1.1) demonstrated significantly lower performance, indicating opportunities for instructional refinement. This pilot study demonstrates that an activity using TikTok® can successfully support key competencies in informatics and medication safety while fostering creativity and student engagement.
Information seeking is widely understood as a curiosity-driven exploration behavior similar to resource foraging. However, it remains unclear whether specific exploration decision mechanisms, such as reward generalization and directed exploration, extend beyond physical consumption domains to the semantic spaces of knowledge and information. How do people choose what to read when navigating vast and unfamiliar content landscapes? We study sequential book selection to investigate this question. At times, readers exploit familiar books they expect to enjoy; at other times, they explore novel options to discover potential rewards. Using a large-scale real-world dataset and a controlled behavioral experiment, we show that book selection is guided by structured generalization across a semantic embedding space and by directed exploration toward options with high uncertainty. Moreover, individual differences in curiosity modulate this exploration-exploitation tradeoff, promoting exploratory reading and increasing enjoyment. These findings demonstrate that core computational mechanisms underlying foraging generalize to epistemic domains and shape real-world media selection.
Wheelchair users with multiple sclerosis (MS) often face barriers that restrict participation in physical activity and exercise training. This manuscript reports on participant feedback to guide evaluating and refining a novel exercise training program, Seated Physical activity INtervention (SPIN). SPIN was adapted from the Guidelines for Exercise in MS (GEMS) approach using a three-step community-engaged research framework based on meeting the needs of wheelchair users with MS. Semi-structured interviews were conducted with 9 participants who completed the 16-week SPIN intervention. The key SPIN intervention components were the exercise prescription, exercise equipment, and behavioral coaching grounded in Social Cognitive Theory. Formative interview domains included overall experience, enjoyable and missing components, delivery modifications, barriers, lessons learned, and additional research topics of interest. Data were analyzed and reported using a rapid qualitative analysis approach. Interviews averaged 16 ± 10 min. Participants reported enjoying SPIN, noting program strengths as being flexible and appropriate for individuals with MS, receiving coaching calls by knowledgeable staff that offered support and accountability, and receiving exercise equipment and video demonstrations. Participants also identified strategies for enhancing the program such as including peer support, offering real-time feedback during exercise, and adding other wellness behavior topics (e.g., diet). The results offer helpful ideas to consider when developing exercise training programs for wheelchair users with MS and other disabilities that may improve health and well-being.
Benjaminse A, Nijmeijer EM, and Gokeler A. Motivation unraveled: paradoxical effects of positive feedback in basketball players. J Strength Cond Res XX(X): 000-000, 2026-Anterior cruciate ligament injury prevention often involves corrective feedback, which can negatively affect player motivation and motor learning. A practice situation with enhanced expectancies (EE) may increase intrinsic motivation and confidence and herewith, self-efficacy. This study investigated the impact of social-comparative feedback during a basketball cutting maneuver. A randomized controlled trial with 2 groups of male basketball players (EE, n = 14, age = 22.4 ± 5.5 years, height = 188.9 ± 9.2 cm, mass = 83.3 ± 11.3 kg and control (CTRL), n = 14, age = 22.3 ± 5.2 years, height = 189.2 ± 8.6 cm, mass = 82.6 ± 11.0 kg) was conducted. All players received veridical feedback during training. In addition, the EE group received false positive comparative feedback. ANOVAs were used to calculate differences between groups with the alpha set at ɑ 0.05 a priori. EE group players had lower expectations (53.0 ± 10.3 vs. 59.5 ± 10.6, p = 0.006), enjoyed the task less (2.9 ± 1.4 vs. 3.8 ± 1.2, p = 0.004), but had greater satisfaction (4.2 ± 1.4 vs. 2.9 ± 1.4, p = 0.017) about their score. This suggests that while EE may increase satisfaction, it can also increase performance pressure, which may hinder enjoyment and ultimately impair optimal skill development. The study highlights the complex interplay between feedback, motivation, and motor learning in anterior cruciate ligament injury prevention.
There is a potential risk of increased dual use of e-cigarettes and cigarettes among people who currently smoke and use e-cigarettes. Limited data are available on why people who smoke in the Philippines use e-cigarettes, including reasons that relate to smoking cessation. The current study addresses this gap to inform e-cigarette regulatory strategy. Data were collected via an online self-administered cross-sectional survey in November 2023 from 611 Filipino adults who smoke and reported current e-cigarette use (i.e. dual users). Participants selected their primary reason for e-cigarette use from a pre-populated list of 15 reasons. We conducted separate logistic regression models of each top reason for e-cigarette use, controlling for demographic and tobacco-use variables. The top primary reasons for e-cigarette use were to cut down smoking (26%), to help quit smoking (24%), to use when not allowed to smoke cigarettes (11.6%), vaping is less harmful than smoking to others around me (11.6%), and 'I enjoy the flavor' (8.5%). Men were more likely than women to select to help quit (adjusted odds ratio, AOR=1.84; p=0.003, 95% CI: 1.22-2.77). Those intending to quit smoking within the year were more likely to select to help quit (AOR=5.22; p<0.001, 95% CI: 2.30-11.9) and to cut down (AOR=2.84, p<0.001, 95% CI: 1.36-5.95), and less likely to select to use when not allowed to smoke (AOR=0.25, p<0.001, 95% CI: 0.13-0.50) and because 'I enjoy the flavor' (AOR=0.24, p<0.001, 95% CI: 0.12-0.49). Some people who smoke in the Philippines use e-cigarettes in order to support smoking cessation; however, there is a risk of prolonged dual use if strong regulations are not implemented to promote complete cessation. Further research should investigate causal factors for e-cigarette use to identify policy pathways for reducing dual use and supporting cessation efforts.
The purpose of this study was to determine the characteristics of programs that anesthesia and neurology residency applicants evaluate when deciding where to apply and rank residency programs and relate these characteristics to the applicant's core values. This was designed as a cross-sectional interview-focused qualitative data study. Interview questions were designed to elicit characteristics of a residency program and applicant values through means-end choice theory. Relationships among characteristics, consequences, and values were determined by one author as informed by the data and themes identified in previous publications. Fourteen interviews were completed (six with anesthesiology applicants and eight with neurology applicants). Common themes were identified in both groups, with no meaningful distinctions identified between the two groups. Program characteristics identified were caseload, foreign student acceptance, interest in applicants, location, mentorship, number of mentors, number of residents, on-call responsibilities, online program information, positive working environment, program stability, reputation, research opportunities, resident support, salary, structure, and teaching opportunities. Consequences identified were acceptance to a program, becoming a competent academic, becoming a competent clinician, completing the program and passing boards, enjoying learning, enjoying work, meeting financial needs, social support, and time outside of work. Values identified were achievement, belonging, impact, security, and well-being. Residency programs should consider how they can align their characteristics with those desired by applicants.
We offer a practical roadmap for implementing Counsel at First Appearance (CAFA) in the United States using evidence from Texas. CAFA consists of early access to legal representation for individuals facing bail adjudications after arrest, a stage of the case in which defendants do not enjoy a federal constitutional right to counsel. Drawing on randomized studies conducted in Texas and observations from jurisdictions that adopted CAFA, the paper outlines a step-by-step approach to implementation. It identifies stakeholders, including judges, public defenders, prosecutors, court administrators, and policymakers-and emphasizes the importance of early coordination and shared objectives. Alongside procedural guidance, the paper presents a set of questions for jurisdictions to consider during planning and rollout. By providing actionable strategies, the paper serves as a resource for jurisdictions and policymakers aiming to enhance fairness and efficiency through CAFA.
A protein-rich and diverse diet is essential for maintaining muscle health, but issues such as eating alone, shopping difficulties, and reduced appetite negatively impact dietary habits in older adults. This study aimed to examine the relationship between eating behavior patterns, food group intake frequency, dietary variety and sarcopenia among community-dwelling older adults. The study included 2004 men and women (72.9 ± 5.5 year old) from the Kashiwa Study, excluding those with cognitive impairment or missing data. Eating behaviors were classified into four clusters using latent class analysis based on 13 eating-related indicators. Dietary content was evaluated by the frequency of intake across 10 food groups and the dietary variety score (DVS). Sarcopenia was diagnosed using AWGS 2019, and logistic regression analysis compared its prevalence among the clusters. The four clusters were: (1) No preparation difficulty, normal appetite type (64.8%, no difficulties, normal food intake), (2) No preparation difficulty, high appetite type (20.0%, large meal size, enjoys meals), (3) No preparation difficulty, low appetite type (11.4%, low appetite), and (4) Preparation-difficulty type (3.8%, difficulty in meal preparation). The DVS did not differ significantly across the four clusters. However, specific food group intake frequencies differed by cluster; the Preparation-difficulty type had lower intake frequencies of meat, seafood, soybean products, and fruits. Sarcopenia risk was lower in the No preparation difficulty, high appetite type (odds ratio 0.7 [0.4-1.3]) but significantly higher in the No preparation difficulty, low appetite type (2.8 [1.9-4.3]) and Preparation-difficulty type (2.3[1.2-4.3]). Eating behavior patterns, such as difficulty with meal preparation and low appetite, are related to specific food group intake frequencies and sarcopenia. These findings suggest that multidimensional assessment of eating behavior may help identify older adults who could benefit from nutritional assessment and support.
Derrick is a 17-year-old young man who presents to the DBP clinic with a several year concern that he is "neurodivergent." He presents with his father, who states that he has been worried as well since Derrick was about 3 years old. He was a late talker, and he had no friends in middle school. He often was teased by his classmates. Derrick's father felt that his primary care clinician did not recognize his concerns, particularly as middle school was at the start of COVID and school shutdowns. Derrick was much happier with virtual learning. When he went back in person at the start of high school, he mostly kept to himself and academically did exceptionally well. He is now in 11th grade and starting the college admissions process, and he has been feeling immobilized about the future. He has started refusing to attend school and he told his pediatric clinician at the last primary care visit in an off-hand manner, that he is "better off dead." He typically goes to sleep around 2 am. He is very groggy for wakeup at 6 am , so his family has been letting him miss school. He is "too sleepy to pay attention." This academic year he has had 30 absences and the school is threatening action, even though he is getting A's to B's on tests. He states he does not enjoy going to school, feels he has no friends, and eats lunch alone. He has not joined any extracurricular activities. Nevertheless, his strongest interests lie in academics, and he scrolls on college websites in the middle of the night, reading course options and intrigued by the possibilities. His primary care clinician referred to a pediatric specialty program. How would you approach his care to support him and his family?
Cancer-related cognitive impairment (CRCI), a common side effect of cancer and its treatment, is characterised by difficulties in memory, attention and executive function. This qualitative sub-study was part of a single-site, parallel-group, pilot randomised controlled trial in which recruitment and retention exceeded our expectations. The aim was to explore participants' experience and motivation for sustained engagement with a web-based cognitive rehabilitation (eReCog) intervention amongst people with aggressive lymphoma who were self-reporting cognitive decline. We used an inductive qualitative approach, conducting semi-structured interviews with fourteen participants. Interviews were recorded, transcribed and a reflexive thematic approach was used to describe and interpret key themes and sub-themes in the data. Fourteen interviews were completed. We extracted four themes describing participants experience and motivation for sustained engagement with eReCog. These included information needs, experience of participation, support and ease of use. Participants were motivated to engage to gain knowledge and strategies to manage their CRCI symptoms; they enjoyed the experience and felt validated via the online community created. Finally, they valued the additional support they received and appreciated the convenience and flexibility of the web-based program. Our findings show that engagement with eReCog was driven by perceived cognitive improvements, psychosocial benefits and accessibility. Addressing both cognitive and psychosocial needs is warranted in web-based rehabilitation to foster continued participation engagement. Web-based cognitive rehabilitation interventions should enhance accessibility and earlier integration into the cancer trajectory to optimise long-term survivorship care in people with haematological cancers should be considered. Australian New Zealand Clinical Trials Registry ACTRN 12623000705684 on 30th June 2023.
Mountain bike terrain parks have become increasingly popular, particularly at ski resorts where chairlifts transport riders uphill to enjoy downhill cycling. These parks feature trails of varying difficulty with artificial obstacles designed for jumps and stunts, which contribute to a unique pattern of injuries. This retrospective epidemiological study analyzed mountain biking injuries in two bike parks in western Austria during the summer seasons of 2023 and 2024. The bike parks are located within two major ski resorts, where lifts transport riders and their bikes uphill. Injury data were systematically documented by bike patrols using an online reporting tool, while exposure data (number of biker visits and number of downhill rides) from one of the bike parks enabled the calculation of an injury rate. A total of 274 injured riders (81.8% male, mean age 30.2 ± 14.6 years), predominantly from Germany (65%), were recorded. Most injuries occurred between Friday and Sunday, primarily between 10 a.m. and 4 p.m., with over 90% occurring during downhill cycling and 15% during the first ride of the day. Falls due to rider errors accounted for 77.4% of injuries, while 20.8% were linked to jump landings. The shoulder/clavicle region was the most frequently injured site (33.7%), followed by the upper extremities (26%) and the head/face region (17%). Fractures were the most common diagnosis, accounting for 52% of cases. Approximately one-quarter of injured riders required helicopter evacuation. The calculated injury rate was 4 injuries per 1000 visits or 6 injuries per 10,000 rides. In conclusion, injuries in bike parks predominantly affect men and are more frequent on weekends. Falls during downhill cycling are the leading cause, with fractures and injuries to the shoulder/clavicle region being the most common. These findings highlight the need for targeted prevention strategies and optimized emergency services to improve safety in bike parks.
Objective This study aimed to assess health knowledge and patient satisfaction in patients undergoing antenatal surveillance. Study Design This is a cross-sectional study that invited patients >18 years old, English-speaking, presenting for antenatal testing via biophysical profile. Patients completed a survey consisting of questions about health knowledge, demographic information, and patient satisfaction. Results A total of 219 pregnant patients completed the survey. The average score on the health knowledge survey was 71.5% (standard deviation [SD] = 16.5). About 25% replied that coming to the weekly ultrasounds was difficult for them, 4% considered the test invasive, and 7% considered the test stressful to their mental health. Approximately 89% stated they felt the doctors explained the reason for the weekly ultrasound, and 92% of respondents stated they enjoyed the weekly ultrasounds. Among patients who identified as Hispanic/Latino, total antenatal knowledge scores were lower (68%, SD = 17.0) than those who identified as non-Hispanic/Latino (76%, SD = 14.7), p -value < 0.001. As education level increased, the total score increased significantly ( p -value < 0.001). No significant difference in total score was seen between varying racial groups nor between varying provider types. Conclusion We found potential modifiable areas for improving health knowledge due to the different ethnic and educational backgrounds. We found an overall high satisfaction rate among the patients.
Disaster education has been using a conventional module-based approach, which is only a one-way information transfer process. This research aims to develop and test the Serious Disaster Games (SDG): Flood Alert to improve flood evacuation behaviour and intrinsic motivation as measured by two indicators, namely knowledge about best evacuation practices and self-efficacy in dealing with flood emergencies. This research used a one-group pre-test-post-test design involving 45 students. The results showed that the SDG: Flood Alert effectively improved students' knowledge and self-efficacy about flood disasters. Most students were able to respond well to actions before, during and after a flood event. Students are confident that they can effectively respond during flooding emergencies. Students with high self-efficacy tend to take protective actions in the face of disasters. The result of the intrinsic motivation assessment found that students enjoy learning by using the SDG: Flood Alert! This study contributed towards enhancement of students' knowledge regarding flood disasters. It was achieved by using the SDG: Flood Alert, which is designed using experiential learning cycle theory, and provides a fun learning experience for students. The SDG: Flood Alert has the potential to be used as a flood disaster learning media for students in flood-prone areas.